CLINICAL HANDBOOK OF SCHIZOPHRENIA

59. Sexuality 607sion leader follows an outline and distributes printed handouts for patients to read andrefer to in the future.Given the problems with verbal learning and memory, “talk groups” and printed assignmentsgo about as far as the next hour in the mind/brain processing of persons withschizophrenia. Nonetheless, programs have been presented that touch on increasing patients’knowledge and comfort about sexual physiology, identifying and clarifying valuesand attitudes about sexuality, overcoming medication-related sexual dysfunctions, andbasic HIV education and proper condom use. In some programs, graphics have been emphasizedto compensate for the cognitive impairments of individuals with schizophrenia.One such program, Choices: An AIDS Prevention Curriculum, is a program forhigh-risk, seriously mentally ill persons subject to sexual exploitation and ignoranceabout sexual practices. Designed to be taught to small groups in four 1-hour sessions,Choices follows a psychosocial education model guided by the emotional and attentionalresponsiveness of the patients. This educational package presents information and encouragesdiscussion and learning through multimedia sources: videos and audiotapes, illustrationsand photographs, printed brochures, games, role plays, quizzes, and problemsolvingand question-and-answer segments. Extensive experience in outpatient, inpatient,and residential settings has shown Choices to be effective, tolerable, and enjoyable for awide variety of patients.Sex Education Course for Young Adults with Schizophrenia at UCLAAt the UCLA Neuropsychiatric Hospital and Behavioral Health Service, an eight-sessionsex education course was devised and offered by the Aftercare Clinic, a program devotedto young persons within 2 years of the onset of their schizophrenia. The aims of thecourse were to help participants gain more knowledge and comfort about their own sexualityand that of others; to identify and clarify their values and attitudes about sexuality;and to acquire decision-making skills regarding sexual relations. The curriculum of thecourse is presented in Table 59.1.When the course was first proposed to the interdisciplinary mental health staff at ateam meeting of the Clinic, there was a collective “gulp and gasp” at the explicitness ofthe material and format. The team members described discomfort at having patients discusstopics such as their previous sexual experiences, number of partners, and sexual dysfunction.In contrast, the course leaders did not discern discomfort among the patients inopen discussion of these topics. As would be expected with low assertive and sociallywithdrawn young persons with schizophrenia, active verbal participation had to be specificallyelicited during the group meetings. The exercises were an excellent means of“warming up” the group to facilitate the sharing of experiences and exploration of attitudes.None of the participants objected to participating, and none avoided answeringrelevant questions about their sexuality. Over the course of the seminar, the atmospherein the group became lighter with appropriate joking, sharing of personal sexual frustrationsand desires, and asking questions. With regular, biweekly ratings made routinely inthis research-oriented setting, it was possible to determine that the presented material didnot lead to any exacerbations of symptoms.FRIENDSHIP AND INTIMACY MODULEAlthough few psychiatric rehabilitation programs have comprehensively addressed thefriendship and intimacy needs of seriously mentally ill persons, the studies conducted to